Ranibizumab for serous macular detachment in branch retinal vein occlusions.

BACKGROUND: The purpose of this study was to compare the efficacy of intravitreal ranibizumab in the treatment of macular edema due to branch retinal vein occlusions (BRVO) with and without serous macular neuroretinal detachment (SMD). METHODS: Forty-nine eyes of 49 patients with macular edema due to branch retinal vein occlusion (22 with SMD and 27 without SMD) were included in this prospective, parallel-group, comparative study. Intravitreal injection of ranibizumab was administered at baseline. Thereafter patients were followed monthly and further injections were performed in the presence of persistence or recurrence of macular thickening. Flattening of the macula was considered success. At the last visit, best-corrected visual acuity (BCVA), and spectral-domain optical coherence tomography (SD-OCT) quantitative parameters (central subfield thickness, cube volume, average cube thickness) were compared between groups. RESULTS: In patients with SMD, BCVA and all the SD-OCT quantitative parameters improved significantly after a mean number of 5.0 ranibizumab intravitreal injections through a median follow-up of 12.5 months (range, 7-34). In patients without SMD, all the variables analyzed improved significantly except for the cube volume, after a mean number of 4.3 ranibizumab intravitreal injections through a median follow-up of 10.4 months (range, 6.5-40.2). The numbers of injections were similar in both groups. The final BCVA was better in patients without SMD at baseline but without significant differences in the SD-OCT parameters between groups. CONCLUSIONS: The presence of SMD may be a baseline predictive factor for ranibizumab treatment outcomes in BRVO patients, with no influence in the number of treatments needed between patients with or without SMD at baseline. Further studies are needed in order to confirm the role of SMD as an independent predicitive factor in cases of BRVO.

Serous macular detachment associated with dome-shaped macula and tilted disc.

INTRODUCTION: An entirely new type of staphyloma has been recently described as dome-shaped macula (DSM). It is characterized by an abnormal convex macular contour within the concavity of a posterior staphyloma. We found DSM associated with serous macular detachment (SMD) and tilted disc in two consecutive cases. CASE REPORTS: Case 1: A 37-year-old female presented to our department because of sudden onset blurred vision in her right eye (OD). The best-corrected visual acuity (BCVA) was 0.5 in both eyes. Funduscopy evidenced bilateral tilted disc associated with posterior staphyloma. Optical coherence tomography (OCT) demonstrated a DSM with SMD in her OD. After 15 months of follow-up, BCVA of her OD remained stable with chronic SMD. Case 2: A 32-year-old female presented to our department because of blurred vision in her OD. The BCVA was 0.4 in the OD and 1.0 in the left eye (OS). Bilateral tilted disc and posterior staphyloma were evidenced in the funduscopy. OCT demonstrated a bilateral DSM with SMD in her OD. After 45 months of follow-up, two further episodes of transient SMD were observed in her OD and seven in her OS. The final BCVA was 0.63 in the OD and 0.8 in the OS. DISCUSSION: SMD associated with tilted disc constitutes a potential cause of subretinal fluid accumulation in myopic patients. OCT is essential for the detection of both SMD and DSM.

Primary intravitreal ranibizumab for adult-onset foveomacular vitelliform dystrophy.

AIM: To evaluate the efficacy of intravitreal injections of ranibizumab in adult-onset foveomacular vitelliform dystrophy (AOFVD). METHODS: Six female patients were misdiagnosed in the office as occult choroidal neovascularization due to AMD, and scheduled for 3-monthly intravitreal injections of ranibizumab. One month after the third injection, all patients underwent further examinations consisting of visual acuity, optical coherence tomography, Indocyanine Green angiography, electrophysiological tests (electroretinogram and electrooculogram), and an exhaustive familial history of macular diseases. Cases were followed-up every 6 weeks since the formal diagnose of AOFVD was evidenced. RESULTS: The mean BCVA improved from 0.36 ± 0.1 at baseline to 0.56 ± 0.1 (p = 0.038). No significant change was evidence in the SD-OCT thickness analysis. Metamorphopsia disappeared completely in all cases after the first injection. No familial history was evidenced. CONCLUSIONS: Ranibizumab intravitreal injections are effective in the short-term BCVA improvement in patients with AOFVD.

Central serous papillopathy by optic nerve head drusen.

We report a 38-year-old man with a complaint of blurred vision in his right eye for the previous 5 days. He had bilateral optic disc drusen. Fluorescein angiography revealed multiple hyperfluorescent foci within temporal optic discs and temporal inferior arcade in late phase. Optical coherence tomography showed bilateral peripapillary serous detachment as well as right macular detachment. This is the first reported case of a concurrent peripapillary and macular detachment in a patient with central serous papillopathy by optic disc drusen. Central serous papillopathy is an atypical form of central serous chorioretinopathy that should be considered as a potential cause of acute loss of vision in patients with optic nerve head drusen.